Surviving Sepsis Campaign 2008: Summary of Recommendation

a) Notes from journal’s authors;

1. These recommendations are intended to provide guidance for the clinician caring for a

patient with severe sepsis or septic shock.

2. Recommendations from these guidelines cannot replace the clinician’s decision-making

capability when he or she is provided with a patient’s unique set of clinical variables

3. Most of these recommendations are appropriate for the severe sepsis patient in both

the intensive care unit (ICU) and non-ICU settings

4. The greatest outcome improvement can be made through education and process

change for those caring for severe sepsis patients in the non-ICU setting and across the

spectrum of acute care

5. Resource limitations in some institutions and countries may prevent physicians from

accomplishing particular recommendations

b) Summary of recommendation;

1. Early goal-directed resuscitation of the septic patient during the first 6 hrs after

recognition

2. Administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic

shock and severe sepsis without septic shock

3. Blood cultures before antibiotic therapy

4. Imaging studies performed promptly to confirm potential source of infection

5. Reassessment of antibiotic therapy with microbiology and clinical data to narrow

coverage, when appropriate

6. A usual 7–10 days of antibiotic therapy guided by clinical response

7. Source control with attention to the balance of risks and benefits of the chosen method

8. Administration of either crystalloid or colloid fluid resuscitation

9. Fluid challenge to restore mean circulating filling pressure

10. Reduction in rate of fluid administration with rising filing pressures and no improvement

in tissue perfusion

11. Vasopressor preference for norepinephrine or dopamine to maintain an initial target of

mean arterial pressure >65 mm

12. Dobutamine inotropic therapy when cardiac output remains low despite fluid

resuscitation and combined inotropic/vasopressor therapy

13. Stress-dose steroid therapy given only in septic shock after blood pressure is identified

to be poorly responsive to fluid and vasopressor therapy

14. Recombinant activated protein C in patients with severe sepsis and clinical assessment

of high risk for death

15. In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage,

target a hemoglobin of 7–9 g/dl

16. A low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung

injury (ALI)/acute respiratory distress syndrome (ARDS);

17. Application of at least a minimal amount of positive end-expiratory pressure in acute

lung injury

18. Head of bed elevation in mechanically ventilated patients unless contraindicated

19. Avoiding routine use of pulmonary artery catheters in ALI/ARDS

20. To decrease days of mechanical ventilation and ICU length of stay, a conservative fluid

strategy for patients with established ALI/ARDS who are not in shock

21. Protocols for weaning and sedation/analgesia

22. Using either intermittent bolus sedation or continuous infusion sedation with daily

interruptions or lightening

23. Avoidance of neuromuscular blockers, if at all possible

24. Institution of glycemic control targeting a blood glucose <150 mg/dl after initial

stabilization

25. Equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis

prophylaxis for deep vein thrombosis

26. Use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2

blockers or proton pump inhibitors and consideration of limitation of support where

appropriate

27. Recommendations specific to pediatric severe sepsis include greater use of physical

Examination therapeutic end points ; dopamine as the first drug of choice for

Hypotension ; steroids only in children with suspected or proven adrenal insufficiency ;

and a recommendation against the use of recombinant activated protein C in children

Taken from:

R. Phillip Dellinger, Mitchell M. Levy, Jean M. Carlet et al , “ Surviving Sepsis Campaign: International

guidelines for management of severe sepsis and septic shock: 2008”, Crit Care Med 2008 Vol. 36, No. 1,

Lippincott Williams & Walkins

Disclaimer: This summary is a personal note belonging to Muhamad Na’im B. Ab Razak for educational

purposes and not to generate income. It is not a publication made by owner but rather a cut and paste of

what he think is important from the original paper.Therefore, author will not taken any responsibility if

there is a misuse of this work.